Among the rarer and more serious lesions of the inherited disease may be mentioned gummatous disease in the larynx and trachea, attended with ulceration and resulting in stenosis; and lesions of the nervous system which may result in convulsions, paralysis, or dementia.

In a limited number of cases, about the period of puberty there may develop deafness, which is usually bilateral and may become absolute.

Changes in the Permanent Teeth.—­These affect specially the upper central incisors, which are dwarfed and stand somewhat apart in the gum, with their free edges converging towards one another.  They are tapering or peg-shaped, and present at their cutting margin a deep semilunar notch.  These appearances are commonly associated with the name of Hutchinson, who first described them.  Affecting as they do the permanent teeth, they are not available for diagnosis until the child is over eight years of age.  Henry Moon drew attention to a change in the first molars; these are reduced in size and dome-shaped through dwarfing of the central tubercle of each cusp.

#Diagnosis of Inherited Syphilis.#—­When there is a typical eruption on the buttocks and snuffles there is no difficulty in recognising the disease.  When, however, the rash is scanty or is obscured by co-existing eczema, most reliance should be placed on the distribution of the eruption, on the brown stains which are left after it has passed off, on the presence of condylomata, and of fissuring and scarring at the angles of the mouth.  The history of the mother relative to repeated miscarriages and still-born children may afford confirmatory evidence.  In doubtful cases, the diagnosis may be aided by the Wassermann test and by noting the therapeutic effects of grey powder, which, in syphilitic infants, usually effects a marked and rapid improvement both in the symptoms and in the general health.

While a considerable number of syphilitic children grow up without showing any trace of their syphilitic inheritance, the majority retain throughout life one or more of the following characteristics, which may therefore be described as permanent signs of the inherited disease:  Dwarfing of stature from interference with growth at the epiphysial junctions; the forehead low and vertical, and the parietal and frontal eminences unduly prominent; the bridge of the nose sunken and rounded; radiating scars at the angles of the mouth; perforation or destruction of the hard palate; Hutchinson’s teeth; opacities of the cornea from antecedent keratitis; alterations in the fundus oculi from choroiditis; deafness; depressed scars or nodes on the bones from previous gummata; “sabre-blade” or other deformity of the tibiae.